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LC Urgent Q1: Scarlet fever

     Following is a question by the Hon Chan Hak-kan under Rule 24(4) of the Rules of Procedure and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 29):


     The cumulative number of cases of scarlet fever (SF) this year has exceeded 600, nearly three times over the record high of 235 infected cases in 2008, and two fatal SF cases have occurred. An increase in the number of SF cases is also noted in neighbouring Macao and the Pearl River Delta (PRD) region, reflecting that the epidemic is spreading in the region. At present, the epidemic in Hong Kong has not yet come under control and is posing a threat to the health of children. The Department of Microbiology of the University of Hong Kong has earlier on performed a genetic study on the bacterium and has discovered the condition of a mutated strain which increases its resistance to antibiotics and transmissibility. In this connection, will the Government inform this Council:

(a) as the genetic mutation of the scarlet fever prevailing in Hong Kong at present has increased the disease's resistance to antibiotics and transmissibility, whether the Government has put in place emergency measures to cope with the spread of SF, such as guidelines on clinical practices and drug utilisation, isolation arrangements and early commencement of the summer break for schools, etc.; if it has, of the circumstances under which the Government will implement such arrangements; if not, whether the Government is of the view that the SF epidemic at present is still under control and its impact on the health of the public is limited; and

(b) whether there is evidence showing signs of abnormality in the spread of SF in the PRD region; if there is, whether the Hong Kong SAR Government, the Macao SAR Government and the health authorities of Guangdong Province have held discussions on the spread of SF and have explored immediate measures to deal with the situation?



     Scarlet fever (SF) is a bacterial infection caused by Group A Streptococcus and mostly affects children under 10 years of age.  The bacteria can be transmitted through either respiratory droplets or direct contact with infected respiratory secretions. For patients with suspected SF, the penicillin group of antibiotics is the treatment of choice and should be given for at least 10 days for effective treatment.

     The Centre for Health Protection (CHP) under the Department of Health (DH) receives case reports of SF under the established statutory notification system. There has been an increase in the number of SF case reports since April this year.

     The underlying reasons for the SF upsurge are being examined. The overall epidemiologic and clinical characteristics of SF cases in this outbreak resemble those in the past, although infrequently some cases may have atypical clinical presentation. The case fatality rate so far is not significantly higher than historical or international figures. In any case, we urge the general public to remain vigilant against the disease.

     My response to the two parts of the question is as follows:

(1) The Government is taking a multi-pronged approach to prevent and control SF in the community, as well as to cope with the potential rise in cases in the coming months.

     CHP is closely monitoring the situation and has been publishing online daily updates on the SF situation in Hong Kong. To enhance monitoring of severe SF cases in the community, CHP has set up an enhanced surveillance mechanism with public and private hospitals for intensive care unit admissions or deaths associated with SF and Group A Streptococcus infection since June 24, 2011.

     The Hospital Authority (HA) has devised guidelines on clinical and drug treatment guidelines in association with CHP.  It will monitor the utilisation rates of Paediatric Intensive Care Units, remind frontline staff on the infection control measures, and ensure the supply of antibiotics.

     In addition, CHP, HA and the University of Hong Kong (HKU) have been working in collaboration on laboratory testing for the bacterium causing SF, including tests on antimicrobial resistance, serotypes, virulence genes and the new gene fragment reported by HKU.

     At an earlier juncture, CHP commissioned the Department of Microbiology of HKU to perform genetic study on the bacterium (Group A Streptococcus) causing scarlet fever. A new genetic fragment was discovered in an isolate of Group A Streptococcus from a SF case in Hong Kong. Given the latest epidemiology and laboratory findings, the two relevant Scientific Committees under CHP are of the view that the relation between this new genetic fragment and the current upsurge in SF requires further scientific investigations. So far, all the isolates detected are sensitive to penicillin.

     On the publicity and education front, CHP has stepped up publicity and health education with regard to SF prevention since June this year. CHP has maintained close liaison and communication with stakeholders and healthcare workers. Letters have been issued to institutions and schools to promulgate prevention and control measures to prevent any potential spread of SF in schools and institutions. Updated situation and information pertaining to clinical diagnosis and management of SF patients have been disseminated through letters to doctors and biweekly publication of Communicable Disease Watch.  

     For the general public, a new radio Announcement in the Public Interest on SF has been produced to strengthen public education.  Health information on SF will be disseminated through various channels, including a designated webpage, posters and leaflets. CHP has also given press briefings and interviews to update the public on preventive measures. These risk communication activities will go on in the coming weeks.

     Regarding school outbreaks, only 7% of all SF cases are associated with school clusters and the number of persons affected in each cluster is small, ranging from 2 to 7 persons. CHP will investigate SF outbreaks and give advice on the management of such cases and appropriate control measures. In special circumstances, CHP may advise individual school with SF case(s) to suspend classes, taking into account the epidemiological assessment.

     We expect high SF activity to persist into the summer. DH has convened an interdepartmental meeting attended by representatives from Social Welfare Department, Education Bureau, Home Affairs Department, Food and Environmental Hygiene Department, Leisure and Cultural Services Department, Information Services Department and HA to plan for the preventive strategies in the coming summer holidays.  Various Government departments will work together to strengthen hygiene measures and publicity on SF at different venues.   

(2) CHP notes a simultaneous increase of SF cases in Mainland China and Macao, where the condition is a notifiable disease as in Hong Kong. The rise of SF cases in Hong Kong is likely a regional phenomenon. Of the 637 SF cases reported this year, only ten cases had history of visiting Mainland China during the incubation period. Based on the Cooperation Agreement on Contingency Measures during Public Health Emergency signed between Guangdong, Hong Kong and Macao, the three places regularly exchange statistics and control measures of infectious diseases such as SF, and notify the concerned counterpart for cross-boundary incidents. Health authorities of Guangdong, Hong Kong and Macao have exchanged the surveillance data and the analysis of SF in view of the rising number of cases this year.

Ends/Wednesday, June 29, 2011
Issued at HKT 12:51


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